I am probably just writing this to 1 or 2 readers as i have left this blog inactive for such a long time.
I did not even realise that this Friday is the CNY, until yesterday.
Life is quiet here, I just want to bring up the family, retire and do whatever then. If I am lucky maybe another 10 years will do, but probably 15-20 years. I did go through a mini mid-life identity crisis, when the ambitious part of me wanted to do something else, but in the end a simple life seems my portion. We should be grateful for whatever position we are in.
So what can you do to enjoy the simple things of life? Well, here’s 1 thing I have been enjoying – the best, freshest and cheapest salmon satsumi! We can get really top quality fresh salmon from Cosco for 4-6GBP a kilo. One big salmon can weigh up to over 3kg. We can cut out a medium box full of salmon pieces from 1 whole fish. And with wasabi paste and soy sauce and coriander… well, I know you can’t get any better than that even in the restaurants.
As for CNY, Grace has got some ‘New Year’ shopping including the sticky new year cake. We will do a small hot pot dinner, just to let children remember their root and tradition. Simple, quiet but hopefully as joyous as back home.
Happy Chinese New Year.
Gee Gee, 加油!
It’s not everyday I get to see an intrathyroidal parathyroid gland. Recently, during an operation for a case of tertiary hyperparathyroidism, both inferior parathyroid glands were found inside the thyroid gland.
Recently just helped a patient to restore his swallowing function.
It is very common to see patients with swallowing problems after their chemoradiotherapy treatment for Head and Neck cancers. Where I practise, oncologists don’t follow up their patients in the long term, but leave that to the Head and Neck surgeons (for practical reason, not because they are lazy). The problem with such practice is that oncologists don’t appreciate the side effects of their treatment as the surgeons. It is not uncommon for patients to stay on lifelong gastrostomy feed, not able to swallow again. Supposedly, chemoradiotherapy is organ preserving treatment. But more and more we are conscious of the fact that it is not organ preservation, but function preservation that matters. It is not easy to see patients expressed their frustration of the suffering they have to put up with the dryness of their throat, nothing helps, not even the artificial saliva. Food never tastes the same again.
The patient that just had pharyngooesophageal dilatation described to me how not only was eating a problem, but when he was sick, he could feel the vomitus coming up from his stomach, but not able to come out to his mouth as it could not get pass the narrow area in his throat. Time and again, he was worried that his gullet was going to explore during each vomiting episode. When I examine his throat, there was no opening that I could see to lead to his gullet. Eventually I had to thread a fine bougie very gently in the middle of the swollen mucosal folds, and gradually opened up his gullet again.
What I think is not right is that patients are often not given the full description of the potential effect of chemoradiotherapy on their quality of life. For operation, we have to ensure that patients understand the effect of potential complications, so that they make an informed decision whether to go for surgery or not. While the oncologists do explain the side effects of chemoradiotherapy, it is a much watered down version of what we later see in the clinic follow up. Indeed I can think of a number of patients who told me they would not have gone for chemoradiotherapy if they had appreciated the side effects.
“Your throat will feel a bit dry, your taste buds may be damaged but they will recover" is not the same as “food will never taste the same again, your throat will be dry and you may need to carry a bottle of water to sip regularly for the rest of life, you will experience swallowing difficulty and there is a small chance that you may not be able to swallow again. "
More and more I am reverting back to favouring surgery if it is a reasonable alternative to chemoradiotherapy to treat cancer. As I always tell my trainees, unless we cut a nerve or remove an organ, people will recover from operation. But they don’t do the same from chemoradiotherapy.
(Disclaimer: this article is not intended to claim that surgery is a suprior treatment modality, each cancer case will have to be discussed and treatment decided by the involved team of specialists. Rather, I am venting my frustration that the side effects of chemoradiotherapy are often not explained clearly to patients.)
Before anybody comes in for an operation, we would hope that the patient has been adequately informed of the operation, why it is done and what to expect after the surgery. Sometimes you will be amazed at the discrepancy between what the surgeon has explained and what the patient understood.
During a certain ward round, a doctor saw a post-op patient who had half his ear chopped off for some sort of skin cancer. The doctor looked at his colleague’s op note, checked the wound and told the nurse that the patient was ready to be discharged.
Just as he was about to move to the next bed, the patient asked: ‘Doc, how long will it take for my ear to grow back?’
It is election time here, and politicians are promising things that they don’t have to deliver themselves.
‘We can now guarantee 1 week wait for cancer results.’
During a post-op ward round, I told a patient who had a lymph node biopsy to return next week for stitches to be removed.
‘I know the politicians guaranteed 1 week wait for the report, but I think you have only 50% chance of getting a preliminary report next week.’
Let me explain, Mr Politician.
After we have sampled a lymph node, it is sent fresh to the laboratory. The lab will prepare the specimen, cut it up and put it into various chemical staining. The initial microscopic studies, although maybe ready within your promised time, is non-diagnostic for lymphoma.
The pathologist will then request immunohistochemical studies, and depending on what they find, may request further more specialised studies. If lymphoma is diagnosed, the specimen is then sent to a dedicated regional pathology expert in haematological malignancy. By the time a central pathology diagnosis is obtained, it will definitely have passed the 1 week guaranteed time.
It is not that the pathologists are not working hard, the problem is that you Mr Politician promised things that you don’t understand. Not all cancers are diagnosed by just a quick glance down the microscopes.
There were patients that I was so certain that they must have lymphoma of some sorts and pre-liminary studies suggested I was right but the final diagnoses were benign conditions like Kikuchi’s disease, Castleman’s disease or simply florid proliferative changes only.
There was another case which I thought at first was tumour of some sort, after second and third opinions several weeks later, the final diagnosis was IgG4 disease.
So, Mr Politician, don’t rush us, we are quite hard working, but we need time to work things out.
Here is another scenario. 繼續閱讀
One question I always find difficult to answer when breaking bad news about incurable cancer is : ‘Doctor, how long do I have (to live) ?’
I have got it horribly wrong in the past. There was some one that I told the family maybe a few months and he passed away that same day. There were others that I thought did not have much time left and they just soldiered on.
I have learnt not to answer that question directly, because I am not God and I honestly don’t know how much time we are left to sojourn on this world. These days, I usually tell my patients if there is anything they wish to do, do it while the body is still able.
Here is another difficult scenario. How do you counsel someone who came to you with a neck lump, otherwise asymptomatic, otherwise fit and well, that he has an incurable cancer, and that statistically speaking he only has months to live??? Would the patient believe you?
You can’t tell him to do his last wishes while the body is still able. He will run across to another doctor for second opinion in no time.
But the scenario is about someone with anaplastic thyroid cancer that has infiltrated the larynx, trachea, oesophagus and with multiple lung metastases. Collectively, the cancer has passed the curable state, but not yet giving the man any problem. 繼續閱讀